OBJECTIVE: The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock. DESIGN: Prospective, observational study. SETTING: Medical-surgical intensive care unit of a teaching hospital. PATIENTS AND PARTICIPANTS: Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12h of admission (Day0), after stabilization of hemodynamics by fluid loading (median volume: 4.9l [lower and upper quartiles: 3.7-9.6l]) and vasopressor therapy, and after vasopressors were stopped (Dayn). MEASUREMENTS AND RESULTS: Thirty-five patients were studied (median age: 60 years [range 44-68]; SAPS II: 53 [46-62]; SOFA score: 9 [8-11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Day0 and Dayn (7 days [range 6-9]), mean left ventricular (LV) ejection fraction (EF) increased (47 +/- 20 vs. 57 +/- 14%: p < 0.05), whereas mean LV end-diastolic volume decreased (97 +/- 25 vs. 75 +/- 20ml: p < 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day0, 12 had normal LVEF on Dayn and 4 patients fully recovered by Day28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110-148ml) on Day0, but none on Dayn. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day0 (3 with normal LVEF), which resolved on Dayn. CONCLUSIONS: This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity. DESCRIPTORS: Shock: clinical studies (38), Cardiovascular monitoring (34).
OBJECTIVE: The objective was to prospectively evaluate cardiac morphological and functional changes using transesophageal echocardiography (TEE) during early septic shock. DESIGN: Prospective, observational study. SETTING: Medical-surgical intensive care unit of a teaching hospital. PATIENTS AND PARTICIPANTS: Ventilated patients with septic shock, sinus rhythm and no cardiac disease underwent TEE within 12h of admission (Day0), after stabilization of hemodynamics by fluid loading (median volume: 4.9l [lower and upper quartiles: 3.7-9.6l]) and vasopressor therapy, and after vasopressors were stopped (Dayn). MEASUREMENTS AND RESULTS: Thirty-five patients were studied (median age: 60 years [range 44-68]; SAPS II: 53 [46-62]; SOFA score: 9 [8-11]) and 9 of them (26%) died while on vasopressors. None of the patients exhibited TEE findings of cardiac preload dependence. Between Day0 and Dayn (7 days [range 6-9]), mean left ventricular (LV) ejection fraction (EF) increased (47 +/- 20 vs. 57 +/- 14%: p < 0.05), whereas mean LV end-diastolic volume decreased (97 +/- 25 vs. 75 +/- 20ml: p < 0.0001). Out of 16 patients (46%) with LV systolic dysfunction on Day0, 12 had normal LVEF on Dayn and 4 patients fully recovered by Day28. Only 4 women had LV dilatation (range, LV end-diastolic volume: 110-148ml) on Day0, but none on Dayn. Doppler tissue imaging identified an LV diastolic dysfunction in 7 patients (20%) on Day0 (3 with normal LVEF), which resolved on Dayn. CONCLUSIONS: This study confirms that LV systolic and diastolic dysfunctions are frequent, but LV dilatation is uncommon in fluid-loaded septic patients on vasopressors. All abnormalities regressed in survivors, regardless of their severity. DESCRIPTORS: Shock: clinical studies (38), Cardiovascular monitoring (34).
Authors: Mitchell M Levy; Mitchell P Fink; John C Marshall; Edward Abraham; Derek Angus; Deborah Cook; Jonathan Cohen; Steven M Opal; Jean-Louis Vincent; Graham Ramsay Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: R Phillip Dellinger; Jean M Carlet; Henry Masur; Herwig Gerlach; Thierry Calandra; Jonathan Cohen; Juan Gea-Banacloche; Didier Keh; John C Marshall; Margaret M Parker; Graham Ramsay; Janice L Zimmerman; Jean-Louis Vincent; M M Levy Journal: Intensive Care Med Date: 2004-03-03 Impact factor: 17.440
Authors: Anne-Sophie Beraud; Cristina Vazquez Guillamet; Jessie L Hammes; Lina Meng; Mark R Nicolls; Joe L Hsu Journal: Am J Med Sci Date: 2014-04 Impact factor: 2.378
Authors: Filippo Sanfilippo; Carlos Corredor; Nick Fletcher; Giora Landesberg; Umberto Benedetto; Pierre Foex; Maurizio Cecconi Journal: Intensive Care Med Date: 2015-03-24 Impact factor: 17.440
Authors: S M Brown; J Pittman; R R Miller Iii; K D Horton; B Markewitz; E Hirshberg; J Jones; C K Grissom Journal: Eur Respir J Date: 2010-06-01 Impact factor: 16.671
Authors: Antoine Vieillard-Baron; Michel Slama; Paul Mayo; Cyril Charron; Jean-Bernard Amiel; Cédric Esterez; François Leleu; Xavier Repesse; Philippe Vignon Journal: Intensive Care Med Date: 2013-01-04 Impact factor: 17.440
Authors: Samuel M Brown; Joel E Pittman; Eliotte L Hirshberg; Jason P Jones; Michael J Lanspa; Kathryn G Kuttler; Sheldon E Litwin; Colin K Grissom Journal: Crit Ultrasound J Date: 2012-05-04